I, the undersigned, certify that I am the owner, or authorized agent for the owner, of the above described animal. I authorize the doctor on duty and assistants to perform the procedures listed above, including the administration of pain relief medications, sedatives, and/or anesthetics, as well as any necessary and appropriate medical, radiology, surgical nursing, diagnostic, and/or emergency care for the animal. I have been advised as to the nature of the procedure and the potential risks and understand that no guarantee of successful treatment can be made. I have been informed and am clear in my understanding of the fees associated with services to be performed. I have read and understand the reasons for and the risks of the above and attached authorized procedure(s), and assume full responsibility for all charges and services incurred to the described animal. I understand that in the event of anesthetic complications or if emergency medications must be administered, additional charges could be incurred.